DESIGNING A SERVICE PORTFOLIO FOR A TAIWANESE HOSPITAL TELECARE CENTER

National Ministry of Health and Welfare defined Tele health care (Telecare) as a combination of medical care, ICT technology, electronic medical equipment, and other cross-cutting professional to allow people to get the health care and preventive health services in the community and familiar home environment and aging in place. To date, telecare has become the world medical technology and services industry trend. However, most elderly are significantly less familiar with technology use than the general population, inhibiting telecare adoption. Based on service portfolio concept, we design core and supplementary service elements for a Taiwanese telecare center. To further examine how patients perceive the values of these service elements in different adoption stages, we conduct surveys with potential clients and current patients of the telecare center. We take customers adoption process as an indicator of “value creation” and examine how the values of service elements vary across different adoption stages. Meanwhile, service quality and productivity should be properly integrated since quality focuses on the benefits created for the customer’s side of the equation, but productivity addresses the financial costs incurred by the hospital. If not properly integrated, these two foci can be in conflict. Thus, our service portfolio will consider not only the value of the services but also the available management resources to run the services. The results suggest approaches to re-allocating the limited resource to the most valuable service elements perceived by customers, and thus help hospitals to drive potential clients, sustain current patients, and maintain service quality of the hospital simultaneously

Exploring Factors That Affect Teleconsultation Adoption: In The Case Of Malaysia

This study identifies the factors that could affect the adoption of teleconsultation technology in public hospitals in Malaysia from the qualitative standpoint. Based on theory-driven and prior-research approach, a conceptual framework was developed and used to facilitate the data collection and analysis processes. The underlying framework derived from a consideration of integrated model of established technology acceptance and diffusion theories and also findings of published telemedicine studies. Semi-structured interviews involving twenty eight key informants coupled with reviews of relevant documents were conducted within eleven participating hospitals to examine the key issues addressed in the framework which subsequently entailed thematic analysis. A summary of six themes and sub-themes drawn upon a priori issues appeared from the patterning of the responses were found to be of great importance in describing teleconsultation adoption phenomenon in Malaysia. Most respondents perceived teleconsultation as beneficial and useful for delivering health services. However the central issues appeared to be more focused on the actual need for the technology, perceived trust in technology and subsistence of facilitating conditions in explaining the way teleconsultation is utilized, suggesting more rigorous research should be conducted to uncover and acknowledge the actionable factors that potentially influence teleconsultation and health information technology adoption

Exploring factors influencing the use of an eHealth intervention for families of children with hearing loss: An application of the COM-B model

BACKGROUND: Prior to developing a successful eHealth intervention, it is important that we explore stakeholders’ capacity to adapt to eHealth. OBJECTIVE: To explore what factors influence the use eHealth services from the perspectives of families of children with hearing loss and professionals who support families as they transition into early intervention. METHODS: A qualitative study incorporating semi-structured in-depth interviews was conducted with families (n = 17) and professionals (n = 11). Interview topic guides were developed based on the COM-B model of behaviour change to explore barriers and facilitators related to capability, opportunity, and motivation. RESULTS: The COM-B model captured several factors that may influence the use eHealth interventions for families of children with hearing loss. The capability factors included computer literacy and familiarity with social media. The opportunity factors were access to online resources, reliable Internet, and affordable equipment. Professionals’ and families’ preferences and a culture of face-to-face services were also identified as barriers for using eHealth. The motivation factors included families’ and professionals’ confidence in using technology and beliefs that there were benefits (e.g., saving travel) associated with using eHealth services. In contrast, beliefs that eHealth may be difficult to set up and not able to replace in-person communication identified as barriers to families and professionals adopting eHealth interventions. CONCLUSION: Findings of this study indicated that implementation of an eHealth intervention could be facilitated by addressing the barriers in stakeholders’ capabilities, opportunities (e.g., equipment and social support), and motivation (e.g., negative beliefs about eHealth) before developing eHealth services

Challenges of Mainstreaming Telecare. Exploring Actualization of Telecare Affordances in Home Care Services

Application of telecare has received increased attention as a means to address the future care needs in home care services. However, the uptake of telecare has been slow and fewer solutions than expected have been implemented. Healthcare employees’ perspectives on telecare and organizational issues have not received appropriate attention in earlier research. There is a need to understand the challenges related to telecare services. Through the lens of affordance theory, the present study aims to explore municipal employees` experiences of TCS. The study contributes to affordance theory by developing an understanding of the collective actualization process. Focus group interviews were conducted with 26 employees involved in telecare services in eight municipalities in Southern Norway. Findings reveal that successful actualization of the seven perceived telecare affordances required involvement of several actors, new ways of working and close cooperation within the municipalities across units and disciplines. Furthermore, the actualization process was strongly influenced by contextual factors. The most prominent factors included anchoring and cooperation, competence and knowledge, and routines and follow-up. Findings indicate that specific focus on these factors is needed in order to succeed with mainstreaming of telecare in home care services

How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews

INTRODUCTION: Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. METHODS: Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. RESULTS: None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0-4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. CONCLUSIONS: Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work

Perception And Utilization Of Telehealth Services Among Home Health Care Agencies: A National Survey

Eun hae Kim Despite the widely known effectiveness of telehealth services in screening and treating both chronic disease and depression in older adults, their adoption among home health care agencies has been slow. Furthermore, there is a lack of empirical research on telehealth use, barriers, and facilitators of adoption in the home health sector. For these reasons, this study examined home health care staff perceptions and use of telehealth for chronic disease and depression care among older patients. Five hundred and sixteen staff from member home health care agencies of the National Association for Homecare and Hospice (NAHC) completed an online survey. The national survey comprised of 33 questions and was informed by the Unified Theory of Acceptance and Use of Technology Model (Venkatesh et al., 2003) and Bobni’ Innovation Culture paradigm. Twenty staff also participated in a 45-minute qualitative telephone interview. The qualitative interview questions focused on telehealth experience and perceived barriers and facilitators to telehealth adoption. Among HHC agencies that reported using telehealth, telephone (63%) and remote-monitoring devices (56%) were the most utilized telehealth technology. Telehealth services included monitoring of health services (64%), chronic disease management (58%), and patient health education (43%). Telehealth was the least used for depression counseling (15%). Overall, there was a positive perception towards telehealth for patient care. However, telehealth was perceived more positively for chronic disease management (90.7%) than for depression care (53%). A majority (74%) perceived themselves as having the knowledge necessary to use telehealth for chronically ill patients while only 32% did for depressed patients. Results suggest that although there is a positive perception towards telehealth for patient care, there are other factors (e.g., lack of resources and reimbursement, training and buy-in from staff or patients) that affect HHC agencies’ adoption and use of telehealth. Therefore, further education is needed to support telehealth use for depression care. Additionally, there needs to be a reimbursement for telehealth visits by HHC agencies, as well as policies and regulations that ensure the quality of care provided by telehealth services. Future studies may consider comparing existing telehealth programs and identifying policies and regulations that are supportive of such programs

User involvement in medical device development: An empirical study

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Changes in population, medical interventions and new technology opportunities, as well as public and political expectations, are all contributing factors to the pressure facing the healthcare system to change. Healthcare in the UK is beginning to move away from its traditional boundaries, for example hospitals and towards patient empowerment and collaboration. Consequently the target users for medical devices have also changed, with new users and user groups emerging. Further to this user involvement is emphatically becoming a part of healthcare delivery in the UK, recognised for bringing improvement in the quality, acceptance and in turn success of a medical device. The changing target market has given rise to the need to understand the newly created user groups and finding new ways to elicit their requirements has become vital for the success of medical devices. This research intends to draw upon and capture the importance of user requirements research, by investigating the early stages of Medical Device Development (MDD) giving particular attention to the conceptualisation of the user within this process. The research shall assess the possible links between user requirement elements, to benefit the healthcare system and investigate how user requirements methodologies that have been proven in other fields can be successfully deployed in the medical device development lifecycle. User requirements methodologies identified within the disciplines of information technology, ergonomics, psychology and design theories relating to medical device design, will be collectively assessed for their capacity to collaborate. The research methodology began with undertaking a systematic review of the literature, which facilitated the construction of a single theoretical conceptual framework of user involvement in medical device development, representative of a superior model of user requirements capture. To validate this framework empirical research followed. This was divided into exploratory, explanatory and interpretive data collection phases, with a view to extract; what the current process of MDD is in industry, why and how users are currently deployed in MDD, and the users perceived experience of involvement. The exploratory study showed that manufacturers were aware of their users and extracting the user requirements effectively was seen as the main competitive differentiator. However, manufacturers were not always aware of the best methods to capture user needs, especially with business objectives and obligatory requirements repeatedly taking precedence over optional user involvement methods. The explanatory study showed that not every department has an equal role to play in terms of user involvement in terms of methods to elicit requirements. However there was consensus across the departments to acknowledge their customers and their feedback to ensure they feel valued. Further to this communicating information to potential new devices users was carried out well in advance of the product coming to market. The customer focus was something not only addressed in the design of the device, but the service that followed. The interpretive study emphasised the importance of understanding the user’s needs and to understand that these needs do change over time. Educating users on disease and self-management was considered important, but realisation by patient user of their responsibility was vital in the successful use of a medical device. The original contributions of this study include its endeavour in taking a multidisciplinary approach to account for users and user involvement methods, and apply to specifically the early stages of the medical device development process. The research developed naturally to transcend and collaborate between these theories, as well as represent various voices within the research to really emphasise the multidisciplinary and multi-user approach it took. This research made a further innovative contribution by developing a framework to the problem of inadequate user involvement in the medical device development process. This could prove very beneficial for medical device manufacturers considering user involvement may become a regulatory requirement, meaning all medical device manufacturers would need to incorporate and document user involvement by law

Redefining the identity of old age through telecare: a Foucauldian inquiry into national care policies and practices at local social care authorities

Since the 19th Century, UK governments have introduced policies to address the problem of old age. These rely upon and reinforce the construction of an ‘old age’ demographic, as a distinct kind of identity based on the knowledge produced about older people across different scientific disciplines. Meanwhile, advancements in medicine and technology, as well as shifts in the political and economic landscape, have had marked impacts on the provision of health and social care. Today, the care information systems technologies known as telecare – increasingly offered by local authorities in accordance with national governmental policies – have been claimed to increase ‘independence’, ‘choice’, and ‘quality of life’ for older people. This thesis makes an enquiry into policies surrounding old age and telecare and into the practices of Surrey’s local telecare initiative as a case study. It contextualises telecare within the wider history of social/health care policy in England to build the case that there are grand narratives of old age embedded in these sociotechnical practices that merit recognition - namely: 1) The biomedical model, which perceives ageing as a pathological problem associated with abnormality, deterioration, and dependency; 2) consumer culture, which perceives older people as a new group of homogenous, financially secure and powerful consumers; and 3) managerialism in social work, which perceives older people in terms of risk. This study utilises critical theory, discourse analysis, and Foucault’s Modes of Objectification to reveal these grand discourses and other discourses of old age, discuss their implications, and explain how they have been perpetuated yet also transformed in the context of telecare. Collectively, their manifestation in the scientific classifications and dividing practices enacted by governments, institutions, and telecare professionals are seen to play a role in the construction of an identity of old age, which has been redefined within the context of telecare information systems

Designing value creating and sustainable business models: An investigation of telehealthcare service ecosystem in North East England

A rising elderly population in England, together with the prevalence of long-term chronic health conditions and higher demands for social care, is creating significant challenges for both the English National Health Service (NHS), and for Local Authorities. These challenges relate to the effective planning, commissioning and provisioning of services for people with complex social and health care needs, amidst a predominantly public-funded health and care system. Digital technology innovations, such as telecare and telehealth (telehealthcare) can facilitate assisted living through technology-mediated preventions, early detections of risks, timely interventions, and self-directed care. Policymakers acknowledge the potential of these technologies to drive greater operational efficiency and cost savings by supporting the policy agenda of ‘ageing in place’, as opposed to an increasing reliance on commissioning expensive institutional provisions such as care homes. In order to realise the opportunities of technology-enabled care, policymakers have started advocating faster adoption, provisioning and implementation of telehealthcare services on an increased population scale. A review of the relevant health technology and systems literature indicates that prior and current research does not sufficiently address the business model and service perspectives, which are considered critical to the practical justification and adoption of complex health service innovations such as telehealthcare. This research study and thesis brings together two interdisciplinary and complementary theoretical frames, synthesised from the extant literature on business models and service innovation. A new theoretical framework is developed in order to examine, interrogate and explain the phenomena of value creation and value realisation within a telehealthcare service ecosystem. Conventional business model-based thinking focuses on value propositions and the financial realisation of value. In contrast, service-dominant logic offers more relational and systemic insights on value co-creation (emphasising social as well as economic factors) through stakeholders’ resource integration within the entire service ecosystem. Using the principles of Critical Realism (CR) to inform a case study approach, this qualitative study employs a multiple case-based research design, resulting in five case studies of telehealthcare services (including one pilot) in the North East of England. The analysis of empirical data collected from the case studies, including a representative sample comprising forty key-informant stakeholder interviews, combined with documentary and observational evidence, reveals four main themes. In the next stage of analysis, following a critical realist perspective, abduction and retroduction based reasoning are applied, leading to a theoretical explanation concerning the underlying structures and their causal powers (mechanisms). Three most significant causal mechanisms, namely Organisational Inertia, Fragmented Ecosystem, and Quasi-market Characteristics, have been identified to explain the stratified reality within a telehealthcare service ecosystem. This research analysis results in both theoretical, and practitioner related contributions concerning the development of a typology for telehealthcare service business models with illustrations of three archetype business models and their related elements. These archetype models signify the dynamic possibilities or potential variations of business models and new service designs contingent upon the operational contexts in which the business models are to be situated